Hoarding Disorder and OCD in DSM V

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Transcript of Hoarding Disorder and OCD in DSM V

Is hoarding disorder distinct from obsessive compulsive disorder and other psychopathology, as suggested in the DSM-5?Obsessive CompulsiveDisorder Highlights of Changes from DSM-IV-TR to DSM-VPeople diagnosed with OCD having hoarding tendenciesRemoved from the anxiety disorders section and a specific section for OCD was established, that also includes other related disorders like hoarding, excoriation, hair-pulling.Inclusion of the substance abuse clause: where some cases of the obsessive compulsive disorder are classified as “substance-induced”.

Poor InsightFairInsightDelusionalInsightBetter Formulation of SpecifierEvaluationDiagnosisTreatmentObsessions and compulsions to amass belongings and hold onto them even though some if not all have very minuscule value. Which specifier(s) is/are a part of the new section on obsessive-compulsive disorders in DSM-V?a) poor insight

b) fair insight

c) irrational insight

d) a and b

e) all of the above

Obsessions over these possessions and because of that have a lot of issues when are asked to get rid of them or even downsize themDSM-V also emphasizes that hoarding tendencies are not seen exclusively in patients with obsessive-compulsive disorder:Present in autism spectrum disordersCognitive impairment disorders

Hoarding DisorderHoarding is…The acquisition of and failure to discard possessions that appear to be useless or of limited value.

Criterion BThe need to purposefully save their possessions and experience distress when faced with having to get rid of them.

The hoarding is not attributable to another medical condition. CRITERION FThe hoarding is not better explained by the symptoms of another mental disorder

Specify if…

1. Excessive acquisition

2. Good or fair insight

3. Poor insight

4. Absent insight/delusional beliefs

Hoarding Disorderand OCDHoarding disorder as a symptom of OCD?Hoarding as a symptom of OCD - Prevalence of hoarding criteria in OCD patients (16 – 20%)o Cases of OCD with a clinically significant hoarding behavior (about 5%)

- Phenomenology of both have some similarities o Avoidance and difficulties of discarding possessions driven by fear of losing items which might be important later on.• Functionally similar to obsessions o Avoidance of discarding, having urges to save items and some acquisition behaviors• Functionally similar to compulsionso Over lapping of symmetry-related obsessions in OCD

Attention Deficit Hyperactivity Disorder• Inattentive symptoms (impaired attention) predict hoarding severity • Hoarders had high ADHD scores• 20% diagnosed with hoarding disorder meet ADHD criteria, only 4% in OCD• 27.8% comorbidity• Information processing deficit underlies hoardingPersonality Disorders• Obsessive Compulsive Personality Disordero In DSM-IV and DSM-5 one of eight diagnostic criteria • “Inability to discard worn-out/worthless objects even when they have no sentimental value.”• Not found in ICD-10• No support for criteria addition • “worthless” aspect counter to hoarding tendencies • Other Personality Disorderso Dependento Schizotypalo Avoidanto Paranoid Alexandra TherondAurelie FockTamraa Greenidge Christina DeguireCriterion CDifficulty discarding possessions resulting in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities)Criterion DThe hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).Criterion E

DSM-IVBeing unable to discard worn-out or worthless objects even when they have no sentimental value

Question: Individuals diagnosed with hoarding disorder have difficulty discarding possessions but do not save them on purpose.